Satisfaction de la prise en charge de la douleur après césarienne au Centre Hospitalier Universitaire de Gynécologie Obstétrique Befelatanana, Madagascar / Satisfaction of the pain management after caesarean section at the Befelatanana University Hospital of Gynecology and Obstetrics, Madagascar

L'évaluation de la satisfaction des patientes est une composante essentielle de l'amélioration de la qualité des services en anesthésie. Notre objectif était de déterminer les bénéfices/risques de la Lidocaïne par rapport à la gestion de la douleur post-césarienne et son coût dans le but d'améliorer la prise en charge des patientes douloureuses. Méthodes : Nous avons procédé à une d'une étude prospective comparative randomisée sur une période de dix mois au sein du Centre Hospitalier Universitaire Gynécologie Obstétrique de Befelatanana. La population d'étude a concerné les femmes opérées pour césarienne sous rachianesthésie. Nous avons évalué la douleur avec la règle EVA (0 à 100 mm) à H1, H2, H3, H4, H8, H12 postopératoire. Résultats : Nous avons inclus 40 patientes pour le groupe A avec Lidocaïne, et 40 patientes pour le groupe B sans Lidocaïne. L'intensité moyenne de la douleur à H12 postopératoire, est de 17,6 ± 11,5 mm pour le groupe A et 29,1 ± 7,4 mm pour le groupe B, avec une différence statistique significative entre les deux groupes (p = 0,008). Conclusion : L'infiltration pariétale de Lidocaïne en peropératoire, pour la prise en charge de la douleur post-césarienne, est bénéfique, comparée au traitement standard seul

Ease of laryngeal mask airway insertion comparison of propofol versus thiopentone and lignocaine in adult patients

Background: A patient is required to be fully relaxed and airway reflexes should be adequately suppressed to allow for smooth insertion of a laryngeal mask airway (LMA).Propofol and a variety of other induction agents and their combinations have been tried to ease its insertion. The use of cheaper alternatives in our environment is highly desirable. Aims and objectives: To compare the ease of insertion of LMA in patients given propofol alone versus thiopentone with lignocaine, as well as assessing the cost effectiveness of these agents in our hospital setting. Methods: This is arandomised single blind prospectivestudy carried out in a Public Tertiary Academic Health Institution. Sixty-four ASA I and II patients equally randomized into 2 groups scheduled for short (not lasting more than one hour) elective gynaecological, orthopaedic, urological and general surgical procedures were recruited into this study. Patients were premedicated with 1g.kg-1 fentanyl intravenously and pre-oxygenated for five minutes. This was followed by an induction dose of either 2.5mg.kg-1propofol (group A) or a sequence of 2mg.kg-1 lignocaine and 5mg.kg-1thiopentone (group B) given by a trained assistant. With the patients in the sniffing position, LMA insertion was attempted immediately after induction of anaesthesia by the anaesthetist (researcher) who observed the ease of LMA insertion using presence or absence of adverse airway responses to LMA insertion such as coughing, gagging, laryngospasm, head and limb movement or inadequate jaw relaxation. These responses were graded as; no response, mild response, moderate response and severe response. Overall assessment of the ease of LMA insertion was then done combining these graded adverse airway responses as; excellent if there were no adverse airway responses, good if responses were mild, satisfactory if responses were moderate and poor if responses were severe with additional anaesthetic required to allow LMA insertion.Results: The average age in group A was 36.5±14 whereas in group B it was 38.7±05 with the p=0.493.There were 22 (56.4%) male patients in group A compared to 17 (43.6%) male patients in group B with p=0.528; whereas, there were 10 (40.0%) female patients in group A compared to 15 (60.0%) female patients in group B with p=0.326. Excellent LMA insertion were observed in 28 (87.5%) patients in group A compared to 27 (84.4%) patients in group B (P= 0.893); Good LMA insertion in 2 (6.3%) patients in group A compared to 1 (3.1%) patient in group B (p= 0.564); Satisfactory in 2 (6.3%) patients in group A compared to 4 (12.5%) patients in group B (p= 0.655).Conclusion: Thiopentone together with Lignocaine provided optimum conditions for laryngeal mask airway insertion comparable to that provided by propofol alone

Anaesthetic agent usage and wastage during caesarean deliveries done with spinal anaesthesia in a labour ward theatre: a concern for the financial implication

Background: Local anaesthesia usage and wastage are common in the operation rooms. The wastage is often not given due considerations. Budgetary allocation for drugs is an identifiable area for cost-cutting and savings. Hence, the need to minimize wastage Objectives: To assess and estimate the amount of local anaesthesia usage and wastage in the labour ward theatre. Also, to analyze the financial implications of the wastages and suggest appropriate steps to reduce the wastages. Methodology: A prospective observational study conducted in the labour ward theatre of a tertiary care hospital. The amount of local anaesthesia administered to the patient during spinal anaesthesia prior to caesarean section was considered the dose used. The wastage was considered as the amount of local anaesthetic agents left unutilized in the syringes, ampules or vials after completion of each caesarean delivery. An estimation of the cost of wasted local anaesthetic agents was made. Result: The local anaesthetic agents being used in significant quantities were hyperbaric bupivacaine, plain lidocaine and lidocaine with adrenaline. The wastage was found more during the use of hyperbaric bupivacaine as the cost of its wastage formed the bulk (N75,000.00/ $210.10) of the estimated total cost of wasted local anaesthetic agents during the study period which was N88, 100.00 ($246.77). Conclusion: There were appropriate uses of the local anaesthesia with respect to the choice and doses for caesarean deliveries but there were wastages often ignored as infinitesimal. In the long run, the wastages become significant and the financial implication scale up the burden of health bills. Effective waste reduction strategies have input in the overall reduction of financial burden associated with health care. Emphasis should be t ailored towards awareness of these wastages among resident doctors and their prudent use of local anaesthesia

Studies on Epidural anaesthesia using lidocaine with adrenaline on hemato-biochemical responses in pregnant West African Dwarf goats

Epidural anesthesia is commonly utilized in veterinary medicine to allow diagnostic, obstetrical, and surgical interventions caudal to the umbilicus in the perineal region of large animal. Addition of a vasoconstrictor to a local anesthetic has been shown to have several beneficial effects. This study was carried out to investigate the effects of lidocaine with epinephrine on physiological, haematological and biochemical parameters in pregnant West African dwarf goats. Four healthy pregnant goats were administered with lidocaine combined with epinephrine (4kg/ml) in the lumbosacral epidural space. Physiological parameters were taken at 30minutes intervals while the hematological and biochemical analyses were done hourly for 3 hours. There were decreases in the hematological parameters including Hb, PCV, RBCs, Neutrophil and platelets after epidural analgesia especially at second and third hours post administration. The glucose, sodium ion, potassium ion, chloride ion, bicarbonate ion increased significantly (P<0.05) at the third hour post administration while the urea and creatinine levels did not show any significant change. The heart rate decreased significantly (P<0.05) post administration of drugs when compared with the onset, respiratory rate increased while the rectal temperature showed a non-significant change. In conclusion, the combination of epinephrine and lidocaine solution for epidural anaesthesia provided a prolonged duration of action without any serious adverse effects in pregnant goats

Xylocaine® 10% Pump Spray as topical anaesthetic for venepuncture pain

Background: Cutaneous analgesia for venepuncture pain can be achieved using various topically applied local anaesthetic formulations. Xylocaine® 10% Pump Spray containing lignocaine hydrochloride and 95% ethanol is exclusively recommended for mucosal anaesthesia. However, this formulation is readily able to penetrate skin. This study investigated whether topical pretreatment with Xylocaine® 10% Pump Spray could facilitate analgesia for venepuncture. Methods: A single-centre, prospective, randomised, double-blind placebo-controlled trial was conducted. One hundred patients were enrolled. The control and intervention groups had 0.5 ml saline and 0.5 ml Xylocaine® applied for 20 min to preselected venepuncture sites. Pain associated with an 18-gauge cannula venepuncture was rated on an 11-point Numerical Rating Scale. A two-point or 30% reduction in pain would be deemed clinically significant. Results: Pain scores were lower (p = 0.001) in the Xylocaine® (median 2; 95% CI 2­3) than the saline (median 4; 95% CI 3­5) group. Moderate-to-severe pain occurred in fewer Xylocaine® (18%) than saline (42%) treated patients (relative risk 0.43, CI 0.22 to 0.48; NNT = 5). Conclusion: Topical Xylocaine® 10% Pump Spray pre-treatment provided a time-effective method of reducing venepunctureassociated pain

Topical Anaesthesia for Pain Relief during High Dose Rate Brachytherapy for Carcinoma of the Cervix

Purpose: To determine the clinical efficacy of a local anaesthetic spray of 10 xylocaine in reducing pain and discomfort in patients undergoing high dose rate (HDR) brachytherapy. Patients and Method: Ninety two consenting patients diagnosed with cervical cancer and planned for HDR as part of their treatment were enrolled for the study. Each patient had three sessions of brachytherapy following the standard procedures. In the first session all the patients had brachytherapy in the usual manner with conscious Sedation with parenteral diazepam and pentazocine. For the second and third sessions; they had treatment sessions using conscious sedation and 10 xylocaine spray and a control session using conscious sedation and a placebo spray with 0.9 normal saline (NS) respectively. Visual Analogue Scale (VAS) was used in assessing pain during each of the procedure. Results: Only 80 patients completed the study. Their age ranged from 28-70 years with a median age of 54 years. The pre-treatment VAS median scores in the treatment and the control sessions were similar at 0.275 and 0.200. However; the post-procedure median VAS scores were increased to 6.3 in the control group and 3.2 in the xylocaine-treated group (P 0.0001). The haemodynamic status including the blood pressure (BP) and pulse rates (PR) were similar pre and post procedure in both groups. Conclusion: Topical xylocaine spray is efficacious in reducing pain and discomfort in HDR Brachytherapy without any appreciable adverse effect

A Comparison of Post-Incisional Subcutaneous; Intramuscular; and Subcutaneous plus Intramuscular Infiltrations of Lidocaine in Post-Caesarean Pain Control

Background. How best to relieve pain after caesarean section (CS) is still debated by many obstetricians. Pre- and post-incisional infiltrations with local anaesthetics have been widely tested and compared. However; the effect of the site of post-incisional infiltration with a local anaesthetic on the quality of pain reduction is not well documented.Objectives. To compare the effects of post-incisional infiltration of lidocaine into the subcutaneous tissue; rectus abdominis; or both subcutaneous tissue and rectus abdominis on pain after CS.Methods. Two hundred candidates for elective CS were randomly allocated to four matched groups of equal size. They received postincisional infiltration of either 1 lidocaine (in the rectus abdominis; the subcutaneous tissue; or both) or saline. The pain intensity and analgesic demand after CS; as well as the time to ambulation and breastfeeding; were documented and compared between the groups.Results. Post-CS pain intensity and analgesic demand were significantly lower; and the time to ambulation was significantly less; in the lidocaine groups than in the placebo group. The time to breastfeeding; however; was comparable between the two groups. Among the patients who received lidocaine; the site of infiltration was associated with no significant differences in terms of post-CS pain intensity and need for analgesics; or time to ambulation and breastfeeding.Conclusion. The site of post-incisional local wound infiltration with lidocaine is not a clinically important factor in pain relief after CS

Toxicite grave des locaux aux chez un nourrisson de 16 mois

L'anesthesie caudale trouve actuellement sa place dans les interventions chirurgicales pediatriques en raison de ses avantages par rapport a l'anesthesie generale. Pourtant; ce type d'anesthesie peut etre egalement a l'origine d'une toxicite grave qui met en jeu le pronostic vital des enfants. Les auteurs rapportent un cas de toxicite grave du au surdosage d'un melange de lidocaine et de bupivacaine chez un nourrisson de 16 mois. Les caracteristiques cliniques de cette toxicite; ses etiologies et sa prise en charge seront discutees par rapport a la litterature